Relative contributions of positive, negative, and adaptive features to limitations in upper-limb function three months after stroke.

PURPOSE: To investigate the contributions of motor impairments to limitations in upper-limb function three months after stroke. DESIGN: Cross-sectional, exploratory study. METHODS: Dependent variable was upper-limb function, measured by the Motor Assessment Scale (MAS), which scores range from 0 to 18. Independent variables included measures of strength, dexterity, spasticity, and contracture of the paretic upper limb. Multiple linear regression analysis was employed to identify which of the independent variables could explain the MAS scores (p<0.05). Analysis was performed with the whole sample and with a sub-group of participants, who had high function (MAS≥12). RESULTS: Sixty-nine individuals participated. Out of them, 63 had high upper-limb function. Regression analysis with the whole sample revealed that strength and dexterity were retained in the models. Together they explained 64% of the variance of the MAS scores (p<0.001), being strength the greater relative contributor. When the regression analysis included only participants with high upper-limb function, dexterity had a greater relative contribution, than strength. Together they explained 52 % of the variance (p< 0.001). CONCLUSIONS: Strength was the main contributor to upper-limb function in individuals three months after stroke. However, in individuals, who already had higher upper-limb function, dexterity showed to be the major contributor.

Access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil is insufficient regardless of the pandemic.

OBJECTIVE: To compare access to rehabilitation professionals by individuals with stroke one month after hospital discharge from a stroke unit in Brazil, before and during the COVID-19 pandemic. MATERIALS AND METHODS: This longitudinal and prospective study included individuals aged 20 years or older without previous disabilities admitted into a stroke unit due to a first stroke. Individuals were divided into two groups: before (G1) and during (G2) the COVID-19 pandemic. Groups were matched for age, sex, education level, socioeconomic status, and stroke severity. One month after hospital discharge, individuals were contacted via telephone to collect data regarding their access to rehabilitation services based on the number of referred rehabilitation professionals. Then, between-group comparisons were conducted (α = 5%). RESULTS: The access to rehabilitation professionals was similar between groups. Rehabilitation professionals accessed included medical doctors, occupational therapists, physical therapists, and speech therapists. The first consultation after hospital discharge was mainly provided by public services. Despite the pandemic, telehealth was not frequent in any period evaluated. In both groups, the number of accessed professionals (G1 = 110 and G2 = 90) was significantly lower than the number of referrals (G1 = 212 and G2 = 194; p < 0.001). CONCLUSIONS: Access to rehabilitation professionals was similar between groups. However, the number of accessed rehabilitation professionals was lower than that of referred ones during both periods. This finding indicates a compromised comprehensiveness of care for individuals with stroke, regardless of the pandemic.

Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study.

OBJECTIVES: To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS: A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS: 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS: A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION: RBR-6bdmsk.

Oxygen uptake efficiency slope in community-dwelling ambulant stroke survivors during walking and stair climbing: a cross-sectional study.

BACKGROUND: Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. OBJECTIVES: To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. METHODS: This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. RESULTS: The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p = .01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI -73 to 772, p = .10). CONCLUSIONS: Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity.

Walking confidence and perceived locomotion ability explain participation after stroke: A cross-sectional experimental study.

OBJECTIVE: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. MATERIALS AND METHODS: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. RESULTS: Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p < .001). CONCLUSION: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke.

Oxygen pulse best predicts energy expenditure during stair ascent and descent in individuals with chronic stroke.

BACKGROUND: To determine whether minute ventilation-to-carbon dioxide production (VE/VCO2), oxygen pulse (VO2/HR), and rate pressure product (RPP: VO2 * HR/1000) can explain energy expenditure during stair ascent/descent and whether energy expenditure during stair ascent/descent can discriminate between walking abilities in individuals with chronic stroke. MATERIALS AND METHODS: Regression analysis of cross-sectional data from 50 individuals between 1 and 4 years post-stroke was carried out to investigate the prediction of energy expenditure during stair ascent/descent. In addition, discriminant analysis was carried out to investigate the discrimination between walking abilities for energy expenditure: community (walking speed ≥ 0.8 m/s) and non-community (walking speed < 0.8 m/s) walkers. RESULTS: Oxygen pulse and rate pressure product were retained in the model. Oxygen pulse alone explained 70% of the variance in energy expenditure during stair ascent/descent. By adding rate pressure product, 79% of the variance was explained. Energy expenditure was able to discriminate the community from the non-community walkers, with a cutoff value of 13.8 ml∙kg-1∙min-1 and correctly classified 62% of the non-community and 78% of the community walkers. CONCLUSION: Oxygen pulse and rate pressure product significantly predicted energy expenditure during stair ascent/descent in individuals with chronic stroke. Energy expenditure during stair ascent/descent discriminated community from non-community walkers.

Canes may not improve spatiotemporal parameters of walking after stroke: a systematic review of cross-sectional within-group experimental studies.

PURPOSE: To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. MATERIAL AND METHODS: Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. RESULTS: Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. CONCLUSIONS: Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority.IMPLICATIONS FOR REHABILITATIONA single-point cane may not improve spatiotemporal parameters of walking after stroke.Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking.Canes may be prescribed without the fear of negatively impairing walking kinematics.

Test-retest reliability and measurement error of the modified gait efficacy scale in individuals with stroke.

PURPOSE: To investigate the test-retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. METHODS: The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test-retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland-Altman plots, were examined. RESULTS: Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient - ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test-retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. CONCLUSION: The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes.

Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the spinal cord injury - Falls Concern Scale.

STUDY DESIGN: Psychometric study. OBJECTIVES: To cross-culturally adapt the spinal cord injury-falls concern scale (SCI-FCS) to the Brazilian Portuguese language and to evaluate its measurement properties. SETTING: SARAH Network of Rehabilitation Hospitals, Belo Horizonte, Brazil. METHODS: The SCI-FCS was translated and culturally adapted to the Brazilian- Portuguese language, following recommended guidelines. The following measurement properties were verified: internal consistency (Cronbach's α), test-retest reliability (ICC and quadratic-weighted kappa coefficients), and construct validity (Rasch analysis). RESULTS: One-hundred and thirty individuals participated. The median SCI-FCS-Brazil score was 27 (22-34). The Cronbach's α was 0.95; ICC was 0.92 (95% CI, 0.86-0.95) for the total test-retest scores, and the Kappa coefficients ranged from 0.04 to 0.87 (95% CI, 0.01-1) for the item-level reliability. Rasch analysis reliability index was 0.81 and 0.98 and the separation index was 2.10 and 6.25 for the persons and items, respectively. Both items and persons fitted the statistics model's expectations, ensuring its unidimensionality. CONCLUSIONS: The SCI-FCS-Brazil showed adequate measurement properties. Its use in manual wheelchair users with SCI is recommended to help defining rehabilitation strategies.

Predictors of return to work after stroke: a prospective, observational cohort study with 6 months follow-up.

PURPOSE: To determine, in Brazil, the proportion of individuals who return to a paid work after stroke, and the factors which predict this. MATERIALS AND METHODS: A prospective observational cohort study was carried out for six months. Participants were recruited early after stroke from four public hospitals. The outcome of interest was return to work, and the following predictors were investigated: age, sex, education, marital status, contribution to household income, type of work, independence, and depression. Logistic regression was used to identify multivariate predictors of return to work. RESULTS: Of the 117 included participants, 52 (44%) had returned to work by 6 months. Contribution to household income (OR 2.4; 95% CI 1.0 to 5.9), being a white-collar worker (OR 4.0; 95% CI 1.8 to 8.6) and being independent in daily activities at 3 months (OR 10.6; 95% CI 2.9 to 38.3), in combination, positively predicted return to work. CONCLUSIONS: Less than 50% of stroke survivors returned to work six months after stroke. Among predictors, only the level of dependence in daily activities is a modifiable factor. Interventions aimed at reducing disability after stroke might increase rates of return to work.Implications for rehabilitationIn Brazil, less than 50% of stroke survivors returned to work six months after stroke.Clinicians may collect information regarding household income, type of work and dependence in daily activities to estimate chances of returning to work, in developing countries.Being independent at 3 months was the strongest predictor of return to work; therefore, interventions aimed at reducing disability after stroke may increase rates of return to work.

Incidence and potential predictors of early onset of upper-limb contractures after stroke.

OBJECTIVES: To investigate the incidence and potential predictors of upper-limb contractures, three months after stroke. DESIGN: Prospective cohort study. METHODS: Consecutive sample of individuals with hemiparesis due to stroke, admitted to a public hospital in Brazil. Contractures were measured by passive range of motion of lateral shoulder rotation, elbow extension, and wrist extension with a gravity inclinometer. Potential predictors included measures of muscle strength, spasticity of the upper-limb muscles, upper-limb function, dexterity, and pain. Measurements were obtained within four weeks and at three months after the stroke. A binomial regression analysis was employed. RESULTS: Out of the 76 individuals with hemiparesis, 28% developed at least one contracture on their paretic upper limb. The incidence of contracture varied across the joints from 6% to 16% and the wrist was the most affected joint. Individuals with moderate stroke showed higher incidence of contracture, compared with those with mild stroke. Dexterity (OR 0.009, 95% confidence intervals (95% CI) 0.00-0.19) and pain (OR 6.417, 95% CI 1.22-33.83) were significant predictors of shoulder, elbow, and wrist contractures. CONCLUSIONS: Individuals with mild and moderate stroke developed upper-limb contractures three months after the onset of the stroke, with an incidence of 28%. The predictors were the presence of pain and loss of dexterity. These impairments should be earlier targeted during rehabilitation interventions.Implications for rehabilitationThe incidence of upper limb contracture 3 months after the stroke is high after mild to moderate stroke.Wrist contractures are the most common upper limb contracture.The presence of pain and loss of dexterity significantly contribute to the development of upper limb contractures.Health professionals should target on the control of pain and improvement of upper-limb dexterity to prevent contractures.

Validation of the telephone-based assessment of locomotion ability after stroke.

The aim of the study was to validate the telephone-based application of the ABILOCO questionnaire for the assessment of locomotion ability after stroke. Individuals after stroke answered the ABILOCO-Brazil questionnaire on two randomized occasions, face-to-face and by telephone, 5-7 days apart. The mean difference between the interviews was reported. Intraclass correlation coefficient (ICC) was calculated to investigate the agreement between the total scores, and weighted-Kappa statistics to investigate the agreement between the individual items. A total of 92 individuals were included. There was no significant difference in the mean scores between face-to-face and telephone-based applications of the ABILOCO [mean difference 0.17 logits; 95% confidence interval (CI), -0.88 to 0.54]. A high level of agreement was found between the ABILOCO total scores obtained between both applications (ICC = 0.90; 95% CI, 0.84-0.93), and most of the individual items had, on average, moderate agreement. The ABILOCO showed to be a reliable questionnaire for telephone assessment of locomotion ability after stroke.

Validation of the Telephone-Based Application of the ABILHAND for Assessment of Manual Ability After Stroke.

BACKGROUND AND PURPOSE: Telephone-based assessment may be a valuable and cost-effective approach to improve monitoring and follow-up assessments in patients and research participants. Telephone-based assessment may be of particular value during times when it is important to reduce in-person contract, such as during the Covid-19 pandemic. The purpose of this study was to investigate concurrent validity of the telephone-based administration of the ABILHAND for the assessment of manual ability in individuals with stroke. METHODS: Using a cross-sectional study design, participants with stroke were invited to answer the ABILHAND questionnaire on 2 randomized occasions, face to face and by telephone, 5 to 7 days apart. The mean difference (MD) between the interviews was calculated (95% confidence interval [95% CI]) to investigate the concurrent validity. Intraclass correlation (ICC) and weighted κ coefficients were used to investigate the agreement between face-to-face and telephone-based administration. RESULTS: One hundred two participants (50 men; mean age = 65 years, SD = 13 years) were included. No significant differences were observed between the mean scores obtained with face-to-face and telephone-based administration of the ABILHAND (MD = -0.06; 95% CI, -0.72 to 0.60). Very high agreement was found between face-to-face and telephone-based administration (ICC = 0.90; 95% CI, 0.85 to 0.93) on the ABILHAND total scores. Most of the individual items had moderate or substantial κ agreement. DISCUSSION AND CONCLUSIONS: Telephone-based administration of the ABILHAND is valid for the assessment of manual ability after stroke. Clinicians and researchers may use the ABILHAND for monitoring manual ability in persons with stroke and/or screening potential research participants.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A318).

Exploratory analysis of randomized clinical trials in physiotherapy aimed at improving walking speed after stroke.

The purpose of the present study was to examine the main characteristics of clinical trials in physiotherapy aimed at improving walking speed after stroke, as well as the correlation between trials' methodological quality and journals' Impact Factor. Searches were conducted on Physiotherapy Evidence Database for all randomized controlled trials aiming at improving walking speed after stroke. Data extracted from the studies were: continent, language, methodological quality, year of publication, number of normalized citations, open access, sample size, measurements of walking speed, interventions, comparators, and prior registration. Data extracted from the journals were: 2018 Impact Factor, open access, endorsement of CONSORT recommendations, predatory classification, PubMed indexing, and Journal Citation Reports category. The main outcomes were journals' Impact Factor, open access, CONSORT recommendations endorsement by the journal, and methodological quality. Spearman correlation coefficients were calculated to explore the relationships between trials' methodological quality and journals' Impact Factor. Two hundred twenty-seven trials were published in 62 journals. The number of trials has increased over the last years. Most of these trials had citations, moderate methodological quality, were published in English, in open access journals, which endorse the CONSORT recommendations, and had Impact Factor ≥2.0. The results indicated a positive, but weak correlation between methodological quality and journals' Impact Factor. Thus, trials in physiotherapy aimed at improving walking speed after stroke have increased over the last years. Overall, trials had moderate methodological quality and were published in journal with moderate-to-high Impact Factor. Best trials were not necessarily published in journals with high Impact Factor.

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

AIM: To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. METHODS: For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. RESULTS: Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. CONCLUSION: The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.

Community-dwelling individuals with stroke, who have inspiratory muscle weakness, report greater dyspnea and worse quality of life.

The objective of the present study was to investigate if different levels of inspiratory muscle strength would be associated with dyspnea, walking capacity, and quality of life after stroke. For this exploratory study, the dependent outcome was strength of the inspiratory muscles, measured by maximal inspiratory pressure. Individuals with maximal inspiratory pressure ≥80 cmH2O were classified as non-weak, those with maximal inspiratory pressure between 45 and 80 cmH2O were classified as weak, and those with maximal inspiratory pressure ≤45 cmH2O were classified as very weak. Related outcomes included dyspnea, measured by the modified Medical Research Council scale; walking capacity, measured by the 6-minute walk test; and quality of life, measured by the Stroke-Specific Quality of Life scale. Fifty-three participants, who had a mean age of 62 years (SD 12) and a mean time since the onset of the stroke of 20 (SD 17) months were included. Significant differences were found only between the weak/very weak and non-weak groups. The mean differences between the non-weak and weak/very weak participants were -1.8 points (95% confidence interval -2.7 to -0.9) for dyspnea and 55 points (95% confidence interval 22-88) for quality of life. Significant correlations were found between measures of inspiratory strength and dyspnea (r = -0.54; P < 0.01) and quality of life (r = 0.56; P < 0.01). There were not found any significant differences or correlations regarding walking capacity. The findings demonstrated that individuals with stroke, who had weakness of the inspiratory muscles, reported greater dyspnea and worse quality of life, compared with those, who did not have weakness. The results regarding walking capacity remain unclear.

Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials.

BACKGROUND: Water-based exercises have the potential to reduce impairments and walking limitations after stroke. OBJECTIVE: To examine the effects of water-based exercises on walking speed, balance, and strength after stroke. DATA SOURCES: Eletronic searches on MEDLINE, CINAHL, EMBASE, Cochrane, PsycINFO, and PEDro databases. ELIGIBILITY CRITERIA: The review included randomized trials. Participants in the reviewed studies were ambulatory adults, who have had a stroke. The experimental intervention was comprised of water-based exercises. DATA SYNTHESIS: Outcome data related to walking speed, balance, and strength were extracted from the eligible trials and combined in meta-analyses. The quality of the included trials was assessed by the PEDro scores and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Thirteen trials involving 464 participants were included. Random-effects meta-analyses provided moderate-quality evidence that water-based exercises significantly increase walking speed by 0.06m/second (95% CI 0.01 to 0.10) and balance by 4.5 points on the Berg Balance scale (95% CI 2.2 to 6.8), compared with land-based exercises, without concurrent changes in strength (MD 5.2Nm/kg; 95% CI -1.4 to 11.9). CONCLUSIONS: This systematic review provided low-quality evidence regarding the efficacy of water-based exercises, compared with no intervention. However, there is moderate quality evidence, which suggested significant benefits of water-based exercises in walking speed and balance, compared with land-based exercises. Differences appear small to be considered clinically relevant, and, therefore, water-based exercises can be prescribed as alternative interventions, based upon individuals' exercise preferences. Systematic Review Registration Number PROSPERO (CRD42018108419).

Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke.

Objective: To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design: Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results: Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Conclusion: Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities.

Associations between walking speed and participation, according to walking status in individuals with chronic stroke.

BACKGROUND: Reduced walking speed (WS) may lead to restrictions in participation of individuals with stroke, however, the relationships between WS and participation still need to better clarified. OBJECTIVE: To evaluate the relationships between WS and participation and compare the levels of participation of individuals with chronic stroke, who were stratified according to their walking status. METHODS: One-hundred and five individuals with stroke (58±12 years; 61 men) participated. WS was measured by the 10-meter walking test and reported in m/s. The participants were stratified into three walking status groups: household (WS <0.4 m/s), limited-community (0.4 m/s-0.8 m/s), and full-community ambulation (>0.8 m/s). Participation was assessed by the Brazilian version of the Assessment of Life Habits 3.1 (LIFE-H 3.1-Brazil). RESULTS: Between-group analyses revealed statistically significant differences between the household, limited-community, and full-community ambulators regarding the LIFE-H 3.1 total (F = 17.5; p < 0.0001), as well the daily activity (F = 12.3; p < 0.0001) and social role (F = 19.0; p < 0.0001) domain scores. Measures of WS were correlated with the daily activity (r = 0.50, p < 0.0001), social role (r = 0.53, p < 0.0001), total LIFE-H scores (r = 0.53, p < 0.0001), and most of the LIFE-H categories (r = 0.23-0.56). CONCLUSIONS: WS was significantly correlated with participation and was able to distinguish between individuals with stroke, who had different levels of participation.

Test-Retest Reliability of the ABILOCO Questionnaire in Individuals with Stroke.

BACKGROUND: The ABILOCO is a self-reported questionnaire, specific for individuals with stroke, for the assessment of ability of locomotion. The ABILOCO has been investigated using the Rasch model and has shown satisfactory measurement properties. However, its test-retest reliability has not been investigated. OBJECTIVE: To investigate the test-retest reliability, that is, agreement, systematic and random variability of the ABILOCO Questionnaire in individuals with chronic stroke. DESIGN: A test-retest reliability study. SETTING: Research laboratory. PARTICIPANTS: Thirty-one individuals (21 men and 10 women; mean age, 60 years), who had poststroke hemiparesis. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENT: The ABILOCO was applied twice, on two occasions, 5 to 7 days apart. Test-retest reliability was investigated, as follows: agreement by the calculation of intraclass correlation coefficients (ICCs); systematic variability by the change in the mean; random variability by the standard error of measurement (SEM) and smallest real difference (SRD). RESULTS: Two outliers were identified in the sample. The ICC values for the whole sample were 0.76 (CI 95% 0.56 to 0.88), whereas the SEM (SEM%) and SRD (SRD%) were 0.55 (21%) and 1.52 (58%), respectively. CONCLUSION: The ABILOCO showed to be reliable to be applied within clinical and research contexts for the assessment of changes in locomotion ability of a group of individuals with chronic stroke. However, it appears to be less suitable to detect changes at individual levels. LEVEL OF EVIDENCE: III.